WO2010129099A9

WO2010129099A9 - Method and apparatus for treating compression fractures in vertebral bodies

Info

Publication number: WO2010129099A9
Application number: PCT/US2010/027832
Authority: WO
Inventors: Patrick O'donnell; Hari Sundram; Mark Johanson
Original assignee: Audax Medical, Inc.
Priority date: 2009-05-06
Filing date: 2010-03-18
Publication date: 2011-05-05
Also published as: US20100070049A1; WO2010129099A1; US20130079878A1

Abstract

A composite vertebroplasty cement for positioning in a void in a vertebral body so as to treat a compression fracture in that vertebral body, the composite vertebroplasty cement comprising: a ceramic component for integrating with the vertebral body so as to treat the compression fracture; and a sealing component for sealing the void in the vertebral body so as to maintain the composite vertebroplasty cement within the void in the vertebral body. A composite vertebroplasty cement for positioning in a void in a vertebral body so as to treat a compression fracture in that vertebral body, the composite vertebroplasty cement comprising: a conventional PMMA bone cement component for integrating with the vertebral body so as to treat the compression fracture; and a sealing component for sealing the void in the vertebral body so as to maintain the composite vertebroplasty cement within the void in the vertebral body.

Description

METHOD AND APPARATUS FOR TREATING COMPRESSION

FRACTURES IN VERTEBRAL BODIES

Reference To Pending Prior Patent Applications

This patent application is a continuation-in-part of pending prior U.S. Patent Application Serial No. 12/436,528, filed 05/06/09 by Patrick O'Donnell et al . for METHOD AND APPARATUS FOR TREATING COMPRESSION FRACTURES IN VERTEBRAL BODIES (Attorney's Docket No. MEDCAP-0204) , which patent application claims benefit of: (i) pending prior U.S. Provisional Patent

Application Serial No. 61/126,684, filed 05/06/08 by Patrick O'Donnell et al . for NOVEL VERTEBROPLASTY CEMENT, AND NOVEL CEMENT CONTAINMENT SYSTEM, FOR USE IN TREATING COMPRESSION FRACTURES (Attorney's Docket

No. MEDCAP-2 PROV) ; and (ii) pending prior U.S. Provisional Patent Application Serial No. 61/201,026, filed 12/05/08 by Patrick O'Donnell et al . for NOVEL VERTEBROPLASTY CEMENT, AND NOVEL CEMENT CONTAINMENT SYSTEM, FOR USE IN TREATING COMPRESSION FRACTURES (Attorney's Docket No. MEDCAP-4 PROV) .

The three (3) above-identified patent

applications are hereby incorporated herein by reference .

Field Of The Invention

This invention relates to orthopedic surgery in general, and more particularly to methods and

apparatus for treating compression fractures in vertebral bodies.

Background Of The Invention

Compression fractures in vertebral bodies are a common occurrence, particularly among the elderly and the physically active (e.g., young athletes).

Compression fractures can lead to serious deterioration of the spine and can cause substantial pain to the patient.

One current treatment for compression fractures involves injecting bone cement (i.e.,

polymethylmethacrylate or "PMMA") into the interior of the vertebral body so as to stabilize the fracture and relieve the pain. More particularly, in this

procedure, an opening is first made into the interior of the vertebral body, then a cavity is created in the interior of the vertebral body, and finally the bone cement (i.e., the PMMA) is injected into the cavity. The bone cement then hardens and provides relief to the patient.

The foregoing procedure is sometimes referred to as a vertebroplasty procedure, and the apparatus used to accomplish the same is sometimes referred to as a vertebroplasty cement system.

Kyphon Inc. of Sunnyvale, CA, among others, has developed substantial technology in the area of vertebroplasty procedures and vertebroplasty cement systems . Unfortunately, current vertebroplasty cement systems all suffer from a significant drawback, namely, that if the PMMA (i.e., the bone cement) extravasates out of the vertebral cavity, it can cause significant harm to the patient. By way of example but not limitation, if the PMMA extravasates out of the vertebral cavity and enters the blood stream, it can create a blood clot and result in a dangerous embolism. Furthermore, if the PMMA extravasates out of the vertebral cavity and enounters neural tissue, it can create neural necrosis (e.g., due to the PMMA' s substantial exothermic properties) . In this respect it will be appreciated that the PMMA is relatively viscous and must generally be injected into the bone cavity under pressure, so there is fair chance that the PMMA can migrate from the injection site to locations outside the vertebral body, e.g., through fractures in the vertebral body. Summary Of The Invention

The present invention is intended to address the foregoing problems by providing a new method and apparatus for treating compression fractures in vertebral bodies. More particularly, the present invention provides a new method and apparatus for performing a vertebroplasty procedure which

substantially eliminates the risk of bone cement migration out of the vertebral body.

In one form of the invention, there is provided a composite vertebroplasty cement for positioning in a void in a vertebral body so as to treat a compression fracture in that vertebral body, the composite

vertebroplasty cement comprising:

a ceramic component for integrating with the vertebral body so as to treat the compression

fracture; and

a sealing component for sealing the void in the vertebral body so as to maintain the composite

vertebroplasty cement within the void in the vertebral body . In another form of the invention, there is provided a method for treating a compression fracture in a vertebral body, the method comprising the steps of:

providing a composite vertebroplasty cement for positioning in a void in a vertebral body so as to treat a compression fracture in that vertebral body, the composite vertebroplasty cement comprising:

fracture; and

a sealing component for sealing the void in the vertebral body so as to maintain the composite vertebroplasty cement within the void in the vertebral body; and

positioning the composite vertebroplasty cement in the void in the vertebral body so as to treat the compression fracture in that vertebral body.

In another form of the invention, there is provided a composite vertebroplasty cement for

positioning in a void in a vertebral body so as to treat a compression fracture in that vertebral body, the composite vertebroplasty cement comprising:

a conventional PMMA bone cement component for integrating with the vertebral body so as to treat the compression fracture; and

vertebroplasty cement within the void in the vertebral body .

In another form of the invention, there is provided a method for treating a compression fracture in a vertebral body, the method comprising the steps of:

a conventional PMMA bone cement component for integrating with the vertebral body so as to treat the compression fracture; and a sealing component for sealing the void in the vertebral body so as to maintain the composite vertebroplasty cement within the void in the vertebral body; and

positioning the composite vertebroplasty cement in a void in the vertebral body so as to treat a compression fracture in that vertebral body.

Brief Description Of The Drawings

These and other objects and features of the present invention will be more fully disclosed or rendered obvious by the following detailed description of the preferred embodiments of the invention, which is to be considered together with the accompanying drawings wherein like numbers refer to like parts and further wherein:

Fig. 1 is a schematic view showing a novel vertebroplasty cement formed in accordance with the present invention; Fig. 2 is a schematic view showing the

vertebroplasty cement of Fig. 1 being injected into a vertebral body;

Fig. 3 is a schematic view showing another novel vertebroplasty cement formed in accordance with the present invention;

Fig. 4 is a schematic view showing the

vertebroplasty cement of Fig. 3 being injected into a vertebral body;

Fig. 5 is a schematic view showing another novel vertebroplasty cement formed in accordance with the present invention;

Figs. 6 and 7 are schematic views showing the vertebroplasty cement of Fig. 5 being injected into a vertebral body;

Fig. 8 is a schematic view showing alternative apparatus for injecting the vertebroplasty cement of Fig. 5 into a vertebral body;

Fig. 9 is a schematic view showing another novel vertebroplasty cement formed in accordance with the present invention; Figs. 10 and 11 are schematic views showing the vertebroplasty cement of Fig. 9 being injected into a vertebral body; and

Fig. 12 is a schematic view showing alternative apparatus for injecting the vertebroplasty cement of

Fig. 9 into a vertebral body.

Detailed Description Of The Preferred Embodiments

The present invention provides a new method and apparatus for treating compression fractures in vertebral bodies. More particularly, the present invention provides a new method and apparatus for performing a vertebroplasty procedure which

Novel Composite Vertebroplasty Cement Comprising Ceramic Component Coated With Sealing Component In one form of the present invention, there is provided a novel composite vertebroplasty cement 5 which comprises two parts: (i) a ceramic component 10 (e.g., hydroxyapatite, tricalcium phosphate, calcium aluminate, etc.) which can integrate with the

vertebral body over time, and (ii) a polymer or fibrin sealing component 15 (e.g., polyethylene glycol or "PEG", carboxymethylcellulose or "CMC", fibrin, polyvinylalcohol or "PVA", etc.) which can create a bound structure. In this form of the invention, ceramic component 10 preferably comprises ceramic particles, and sealing component 15 is coated on the outside of the ceramic particles 10. See Fig. 1.

Thus, sealing component 15 is effectively bundled with ceramic component 10 so that the two can be delivered to the fractured interior of the vertebral body in conjunction with one another.

In use, a cavity 20 may or may not be created in the vertebral body in the traditional manner, and then novel composite vertebroplasty cement 5 is injected into the vertebral fracture. See Fig. 2. When blood in the vertebral body reacts with sealing component 15, the blood activates sealing component 15, causing sealing component 15 to quickly adhere and set, thereby locking the vertebroplasty cement 5 within the vertebral body. More particularly, when blood in the vertebral body encounters the vertebroplasty cement 5 in cavity 20, the cement's sealing component 15 activates so as to adhere and set. This action converts the heretofore-fluid vertebroplasty cement 5 into a solid mass which adheres to the walls of cavity 20. Thus, vertebroplasty cement 5 is sealed within cavity 20 in the vertebral body, with ceramic

component 10 present to integrate with the vertebral body and address the compression fracture.

Thus, the novel composite vertebroplasty cement 5 (i) is an easily flowable mixture prior to exposure to blood in the vertebral body, whereby it can be

injected into cavity 20 in the vertebral body, (ii) comprises a ceramic material 10 which can integrate into the vertebral body so as to address the

compression fracture, and (iii) comprises a sealing component 15 which, when contacted by blood in the vertebral body, quickly adheres and sets, thereby locking composite vertebroplasty cement 5 in position within the vertebral body and eliminating the danger of cement extravasation. Significantly, since the novel composite vertebroplasty cement contains no PMMA, little harm will be done to the body even if some cement extravasation should inadvertently occur.

Composite Vertebroplasty Cement Comprising A Slurry Of The Ceramic Component And Sealing Component

In another form of the present invention, there is provided a novel composite vertebroplasty cement 5 which comprises a slurry of the aforementioned ceramic component 10 and the aforementioned sealing component 15. See Fig. 3. Thus, in this form of the

invention, sealing component 15 is again effectively bundled with ceramic component 10 so that the two can be delivered to the fractured interior of the

vertebral body in conjunction with one another.

In use, a cavity 20 may or may not be created in the vertebral body in the traditional manner, and then the novel composite vertebroplasty cement 5 is injected into the vertebral fracture. See Fig. 4. When blood in the vertebral body reacts with the sealing component, the blood activates the sealing component, causing the sealing component to quickly adhere and set, thereby locking vertebroplasty cement 5 within the vertebral body. More particularly, when blood in the vertebral body encounters vertebroplasty cement 5 in cavity 20, the cement's sealing component 15 activates so as to adhere and set. This action converts the heretofore-fluid vertebroplasty cement 5 into a solid mass which adheres to the walls of cavity 20. Thus, vertebroplasty cement 5 is sealed within the cavity in the vertebral body, with the ceramic component present to integrate with the vertebral body and address the compression fracture.

Thus, the novel composite vertebroplasty cement (i) is an easily flowable mixture prior to exposure to blood in the vertebral body, whereby it can be

injected into the cavity in the vertebral body, (ii) comprises a ceramic material which can integrate into the vertebral body so as to address the compression fracture, and (iii) comprises a sealing component which, when contacted by blood in the vertebral body, quickly adheres and sets, thereby locking the

composite vertebroplasty cement in position within the vertebral body and eliminating the danger of cement extravasation. Significantly, since the novel

composite vertebroplasty cement contains no PMMA, little harm will be done to the body even if some cement extravasation should inadvertently occur.

Serial Delivery Of The Sealing Component And The Ceramic Component Of The

Composite Vertebral Cement

In another form of the present invention, composite vertebroplasty cement 5 can comprise two separate components delivered in a serial fashion. More particularly, in this form of the invention, composite vertebroplasty cement 5 comprises the aforementioned ceramic component 10 and the

aforementioned sealing component 15. See Fig. 5.

However, in this form of the invention, the components are kept segregated from one another prior to use. Then, at the time of use, the sealing component is delivered first so as to fill in the intersticies in the fractured vertebra. See Fig. 6. When blood in the vertebral body encounters the vertebroplasty cement in the cavity, sealing component 15 activates so as to set and thereby seal the intersticies of the fractured vertebra at the peripheries of the

intersticies, i.e., at the locations where blood can contact sealing component 15. Thereafter, ceramic component 10 is injected into the bone void which has been sealed with the sealing component. See Fig. 7. Ceramic component 10 is thereafter locked to sealing component 15 as more blood seeps into sealing

component 15. If desired, more sealing component 15 can thereafter be added to ceramic component 10 so as to further seal off the mass. As a result, the composite vertebroplasty cement 5 can address the fracture in the vertebra while still eliminating cement extravasation out of the vertebral body.

If desired, sealing component 15 and the ceramic component 10 can be packaged into a dual-chamber syringe 25 so that the syringe needle does not need to be removed and re-inserted between component

deployments. See Fig. 8.

Composite Vertebroplasty Cement Comprising A Sealing Component And Conventional PMMA Bone Cement, With The Sealing Component And The Conventional PMMA Bone

Cement Being Delivered Serially In another form of the present invention, there is provided a composite vertebroplasty cement 5 which comprises a sealing component 15 and conventional PMMA bone cement 30. More particularly, in this form of the invention, sealing component 15 may comprise the polymer or fibrin sealing component (e.g.,

polyethylene glycol PEG, carboxymethylcellulose, fibrin, polyvinylalcohol PVA, etc.) discussed

previously. Conventional bone cement 30 can comprise polymethylmethacrylate (PMMA) bone cement. See Fig. 9. The conventional bone cement 30 can integrate with the vertebral body and address the compression

fracture. Sealing component 15 is delivered first, so as to fill in and seal the intersticies in the

fractured vertebra. See Fig. 10. Then the

conventional bone cement 30 (e.g.,

polymethymethylacrylate PMMA, or ceramic material such as TCP/HA etc.) can be safely injected into the opening, with sealing component 15 retaining

conventional bone cement 30 within the bone and preventing leakage therefrom. See Fig. 11.

Preferably, conventional bone cement 30 is then

"capped" with a further layer of sealing component 15, with the capping layer of sealing component 15

thereafter adhering and setting, whereby to completely seal in the conventional bone cement 30 within the bone. Conventional bone cement 30 can thereafter cure in situ so as to provide the desired structural integrity to the bone, without fear of cement

extravasation .

If desired, sealing component 15 and the

conventional PMMA bone cement 30 can be packaged into a dual-chamber syringe 25 so that the syringe needle does not need to be removed and then re-inserted between component deployments. See Fig. 12.

In one preferred form of the invention, sealing component 15 is engineered and configured so that:

(i) sealing component 15 can reliably prevent conventional bone cement 30 extravasation, whereby to minimize the possibility of embolisms, exothermal nerve root damage and/or hypotension - and by

configuring sealing component 15 so that it can reliably prevent cement extravasation, the need to use cavity creation devices (e.g., inflatable balloons) to prevent cement extravasation can be eliminated (of course, it may still be desirable to use cavity creation devices for other purposes, e.g., for height restoration in a fractured vertebral body, etc.);

and/or

(ii) sealing component 15 can serve as a "heat sink" for the exothermic reactions of the conventional PMMA bone cement 30; and/or

(iii) sealing component 15 can serve as a cushion to modify the stiffness of the PMMA implant, whereby to minimize endplate fractures of the vertebral body; and/or

(iv) sealing component 15 can serve to

encapsulate tricalciumphosphate-hydroxyapatite

(TCP/HA) ceramic injectables to prevent giant cell infiltration .

Among other things, sealing component 15 may comprise a polymer.

Where sealing component 15 comprises a polymer, the polymer may be non-degradable or degradable. If the polymer is degradable, the polymer is configured so that the degradation products are non-toxic and preferably eliminated from the site of implantation. If the polymer is non-degradable, the polymer is engineered so that the long term stability of the solid polymer is satisfactory for vertebroplasty cement applications. Preferably the monomeric units of the polymer chain are of the sort well known to the FDA.

Furthermore, where sealing component 15 is a polymer, the polymer is preferably engineered and configured so that it has the ability to go through a phase change, e.g., from a flowable liquid at the time of injection to an elastic solid at the site of implantation in the body. This phase change can be either physical or chemical in nature. Furthermore, this phase change can be reversible or non-reversible in nature. By way of example but not limitation, the polymer may comprise a phase change elastic thermal plastic, or a phase change hydrogel, etc.

In one preferred form of the invention, sealing component 15 is engineered and configured so that it includes dimethylacrylamide (DMA) . The DMA acts as a plasticizer for the polymer as well as to stimulate an osteoinductive bone regeneration cascade.

Preferably the polymer is stable at room

temperature, does not employ the use of catalysts such as metals, and is sterilizable (e.g., via sterile filtration, gamma irradiation, etc) .

Thus it will be seen that the novel method and apparatus of the present invention provides a

significant advantage over prior art vertebroplasty methods and apparatus, successfully treating the compression fracture while reliably eliminating the risk of cement extravasation. More particularly, the method and apparatus of the present invention provides the desired therapeutic benefits needed to address compression fractures, while simultaneously

substantially eliminating the risk of bone cement extravasation. As a result, the present invention effectively eliminates the clotting and embolism issues, and the neural necrosis issues, present with conventional vertebroplasty therapies.

It should be appreciated that the present

invention may also be used for bone grafting

applications. More particularly, the present

invention can be used to temporarily adhere a bone graft to a host bone, with the novel composite bone cement providing both adherence and an osteoconductive matrix .

The present invention may also be used for numerous other bone therapies which will be apparent to those skilled in the art in view of the present disclosure .

Modifications Of The Preferred Embodiments

It should be understood that many additional changes in the details, operation, steps and

arrangements of elements, which have been herein described and illustrated in order to explain the nature of the present invention, may be made by those skilled in the art while still remaining within the principles and scope of the invention.

Claims

What Is Claimed Is

1. A composite vertebroplasty cement for positioning in a void in a vertebral body so as to treat a compression fracture in that vertebral body, the composite vertebroplasty cement comprising:

fracture; and

vertebroplasty cement within the void in the vertebral body .

2. A composite vertebroplasty cement according to claim 1 wherein the ceramic component comprises a plurality of particles, and further wherein the sealing component comprises coatings on the plurality of particles.

3. A composite vertebroplasty cement according to claim 1 wherein the ceramic component comprises a plurality of particles and the sealing component comprises a flowable mass, and further wherein the vertebroplasty cement comprises a slurry of the ceramic component particles in the flowable mass of the sealing component.

4. A composite vertebroplasty cement according to claim 1 wherein the ceramic component and the sealing component are segregated from one another prior to use.

5. A composite vertebroplasty cement according to claim 1 wherein the ceramic component comprises at least one from the group consisting of:

hydroxyapatite, tricalcium phosphate and calcium aluminate .

6. A composite vertebroplasty cement according to claim 1 wherein the sealing component comprises at least one from the group consisting of a polymer and fibrin .

7. A composite vertebroplasty cement according to claim 1 wherein the sealing component comprises at least one from the group consisting of polyethylene glycol (PEG) , carboxymethylcellulose (CMC) , fibrin and polyvinylalcohol (PVA) .

8. A method for treating a compression fracture in a vertebral body, the method comprising the steps of:

fracture; and

9. A method according to claim 8 wherein the ceramic component and the sealing component are simultaneously positioned in the void in the vertebral body .

10. A method according to claim 8 wherein the ceramic component and the sealing component are serially positioned in the void in the vertebral body

11. A method according to claim 10 wherein the sealing component is positioned in the void in the vertebral body before the ceramic component is

positioned in the void in the vertebral body.

12. A composite vertebroplasty cement for positioning in a void in a vertebral body so as to treat a compression fracture in that vertebral body, the composite vertebroplasty cement comprising:

vertebroplasty cement within the void in the vertebral body .

13. A composite vertebroplasty cement according to claim 12 wherein the ceramic component and the sealing component are segregated from one another prior to use.

14. A composite vertebroplasty cement according to claim 12 wherein the sealing component comprises at least one from the group consisting of a polymer and fibrin .

15. A composite vertebroplasty cement according to claim 12 wherein the sealing component comprises at least one from the group consisting of polyethylene glycol (PEG) , carboxymethylcellulose (CMC) , fibrin and polyvinylalcohol (PVA) .

16. A method for treating a compression fracture in a vertebral body, the method comprising the steps of:

a sealing component for sealing the void in the vertebral body so as to maintain the composite vertebroplasty cement within the void in the vertebral body; and positioning the composite vertebroplasty cement in a void in the vertebral body so as to treat a compression fracture in that vertebral body.

17. A method according to claim 16 wherein the conventional PMMA bone cement component and the sealing component are serially positioned in the void in the vertebral body.

18. A method according to claim 17 wherein the sealing component is positioned in the void in the vertebral body before the PMMA bone cement component is positioned in the void in the vertebral body.